Is your claims adjuster trying to find coverage for your loss or are they trying to find exclusions of coverage.

This subject is at the center of every relationship between an Insurance Carrier and their Insured. What duties does the insurance company truly owe their insured when reviewing or analyzing coverage?

One of my favorite texts that describes the relationship between an insured and their claims representatives was written in 1993 in the claims adjusting training text for AIC 33 by Markham, James J. The Claims Environment. Malvern: Insurance Institute of America, 1993 print which says on page 13 paragraph 3:

“The primary duty of the claim representative is to deliver the promise to pay. Therefore, the claim representative’s chief task is to seek and find coverage, not to seek and find coverage controversies or to deny or dispute claims. Because of the personal relationship formed in an insurance transaction, the insurance company should not place its interests above the insured’s. The claims professional handling claims should honor the company’s obligations under the implied covenant of good faith and fair dealings.”

This is one of the most powerful descriptions of what the relationship between and insured and their Insurance carrier is supposed to be. The consumer is at a disadvantage when negotiating an insurance claim as they don’t have a say in what is written in the policy and most-often do not understand much of the policy. More importantly, they are relying on the insurance company to stand by their promise of coverage in the event of a loss. There are several reasons why there is an implied covenant of good faith, but that is a topic for another post.

With the goal of Good Faith claims handling in mind, searching high and low through the policy to find coverage should be the number one goal of a claims agent in every case. Unfortunately, over the past several years, our experience has been that the claims agents are moving farther and farther away from looking for coverage and more toward trying to find ways to deny coverage. Good Luck on your claims.

If you have a claims question, feel free to contact justin@skiptoninc.com or call us at 877.992.7577.